The Dangerous Connection Between Diabetes and Heart Attacks: Are You At Risk?

The risk of heart disease increases with diabetes. Heart disease, also known as cardiovascular or coronary disease, can lead to a heart attack or stroke. A diabetes patient is twice as likely to develop heart disease and suffer a heart attack than someone who doesn’t have diabetes, and at a younger age as well. The longer you suffer from diabetes, the more your risks of heart complications increase.

Cardiovascular conditions affect your blood circulation too. This, in turn, make your diabetes complications worse. Thus begins a vicious cycle between heart disease and diabetes in which poor management of one condition worsens the other.

Diabetes and your heart

The health of your heart depends on the health of your veins and arteries. With diabetes and high blood sugar levels, the blood vessels and the nerves that control your heart can get damaged.

People with diabetes also face a greater danger of heart failure. With heart failure, the heart is unable to pump blood throughout the body effectively. This can lead to a build-up of fluids in the lungs and make breathing difficult.

Diabetes also increases the risk of other medical conditions that are detrimental to your heart health:

• High cholesterol or triglycerides: Low HDL cholesterol (“good” cholesterol) and high LDL (“bad” cholesterol) can lead to the hardening of arteries.
• High blood pressure: Your cardiovascular health suffers from having diabetes and high blood pressure with the increased force of blood through your arteries damaging artery walls.

Can you get “silent” heart attacks?

A common side effect of diabetes is neuropathy. Neuropathy is a kind of nerve damage that causes symptoms such as numbness, weakness in the extremities (hands and feet), and tingling sensations. This condition can also damage nerves that lead to your blood vessels and heart, making it difficult for you to gauge warning signals like pain and discomfort in your body.

In such a scenario, neuropathy can mask the pain and symptoms of a heart attack. A sort of mute button on the pain associated with a heart attack in the jaw, chest, and arm may seem fortuitous, but can be deadly if the patient is unable to identify the tell-tale symptoms of a heart attack and seek timely medical intervention.

Managing diabetes for taking care of your heart

The link between heart health and diabetes is not just down to elevated blood sugar levels; there are other conditions, such as high blood pressure and cholesterol, that go together in damaging blood vessels and complicating heart conditions.

The following tips and lifestyle changes can help you manage diabetes and your heart:

• Get regular exercise:
  Increased physical activity helps manage diabetes by improving your body’s sensitivity to insulin, the hormone that regulates blood sugar levels. Regular exercise also improves your heart health and reduces blood sugar levels. You should aim to get at least 150 minutes of moderate–intense exercise, such as brisk walking or light jogging, every week.

  
  

• Maintain a healthy body weight:
  For overweight diabetic patients, even modest weight loss of 5% - 7% of body weight can result in a considerable reduction in blood sugar and cholesterol.

  
  

• Follow a healthy, balanced diet:
  Avoid processed carbohydrates such as most fast foods, sweets and sugary drinks, and foods made from all-purpose flour. Reduce your alcohol and red meat consumption. Eat more vegetables and fruits, whole grains, and lean proteins.

  
  

• Reduce stress:
  Stress is closely linked to cortisol levels and blood pressure. Sustained stress is one the most common causes of high blood pressure and in turn can lead to unhealthy habits such as excessive drinking, eating, and smoking. To manage stress, seek help from friends and family, a mental health counsellor, try meditation, or get regular exercise.

  
  

• Manage your ABCs:
  

  • A: Get your HbA1C tests done every 2 – 3 months to measure your average blood sugar levels and try to keep them in the target range as recommended by your doctor.
  • B: Try to keep your blood pressure to levels below levels recommended by your doctor.
  • C: Manage your cholesterol levels.
  • s: Stop smoking (and avoid starting at all costs.)

People with diabetes are at a much higher risk of developing heart disease and heart attacks. Minimising risks of heart attacks that arise with diabetes isn’t just down to keeping your blood sugar in check – it is important to manage other contributing factors as well. In addition to the steps mentioned above, your doctor may also prescribe you medication to manage your blood sugar, cholesterol and triglyceride levels, and blood pressure to reduce the risk of a cardiovascular event.

For more detailed information about diabetes, heart conditions, and how to prevent emergencies like heart attacks, book an appointment with the best heart specialists in Bangalore at the Sagar Heart and Vascular Institute.

Insomnia In Teens Can Cause Heart Attacks

A vast number of adolescents are not getting sleep regularly. Though this may not come as a surprise to many parents, this trend can have a worrying impact on teenagers’ heart health. Health experts recommend more than 8 hours of sleep for adolescents aged 14 – 17 and more than 9 hours of sleep for those aged 11 – 13. Only about 50% of children get more than 7 hours of sleep, with older teens sleeping even less than their younger counterparts.

Why is sleep important?

As adults with many responsibilities, a good night’s sleep may seem like a luxury. However, sleep plays an integral role in the body’s recovery and optimal functioning. Good quality sleep is important for mental health, energy levels, blood pressure, metabolism, and – in particular – cardiovascular health.

Insomnia has high comorbidity with many cardiovascular diseases, including coronary heart disease, hypertension, incident cardiovascular disease, and heart failure. Additionally, regular poor sleep increases the risks of medical conditions such as diabetes and obesity and shortens life expectancy.

What are the risks for our teenage children?

Previous research has found links between insomnia in children and childhood obesity, and consequently, with higher blood pressure. As per a study published in the journal Pediatrics, researchers found that nearly 33% of adolescents slept for around 7 hours every night and that nearly half of them were fully asleep for less than 85% of the sleep time. All in all, the median sleep duration was a measly 7.35 hours every night for around 800 adolescents in the study ranging 11 – 17 years in age.

Researchers found that teenagers who did not get adequate sleep regularly had a higher body mass index (BMI) and belly fat, high blood pressure, abnormal cholesterol or blood lipids, and insulin resistance – a condition that increases the risk of diabetes.

All these comorbidities can drastically increase the risk of cardiovascular disease in teenage adolescents.

Why are our teenagers not sleeping properly?

Though medical conditions such as sleep apnoea affect sleep patterns directly in around 25% of men and around 10% of women, the primary cause of poor quality and inadequate sleep is mostly down to the lifestyle and poor sleeping habits.

Teenagers are caught between long school days, homework, projects, extra-curricular activities, with early school timings contributing to less sleep. With Generation Z brought up on mobile devices and social media, phone screens and computers take up a majority of the attention span of young and older teens. They ignore sleep, stay up late with the blue light from their devices keeping their brains awake, making it harder for them to fall asleep. In fact, the CEO of Netflix, Reed Hastings, once declared that the streaming service’s biggest competition is sleep – and that they’re winning.

How do we get teenagers to improve their sleeping habits?

When it comes to sleep and its dangers to our teenager’s heart health, we cannot just sit back and claim that “teens will be teens.” Their future health is at risk and this situation demands action.

The following tips can help your teenagers get the sleep they need:

• Develop discipline with devices and time on electronics:
  Make a rule that electronic screens and devices are powered down close to an hour before bedtime. Have your teen put his or her phone, tablet, laptop, and other mobile devices somewhere besides his or her room.

  Light-emitting devices and “blue light,” in particular, block the release of the sleep hormone melatonin and delay sleep. Also, just knowing that the device is at an arm’s length and new content and notifications is available in the app feed are adequate to keep your teen’s mind awake.

  
  

• Plan and prioritise sleep:
  If daily activities and school work make it impossible for your teen to get the necessary 8 hours of sleep, something has to give. Sit with your child, map out the day, and evaluate the way your teen spends his or her day. You will soon find the activities to prioritise to ensure good sleep for your teen.

  
  

• Go sugar- and caffeine-free after 5 PM:
  The caffeine and “sugar rush” from energy drinks, sugary sodas, and other sweets stay in your teen’s system for about 4 to 5 hours. Staving off these foods well before sleep time will help negate their ability to keep your child awake past his or her bedtime.

  
  

• Set sleep goals:
  Use reminders or alarms to remind your teenager of the time to start winding down and settle down to sleep. You can also encourage your teenager to make “sleep pacts” with his or her friends so that they all turn off their phones and say their goodnights at the same time.

  
  

• Maintain a regular schedule:
  Do not fall into the trap of “catching up on sleep” on weekends. Averaging out lost sleep over weekdays/ school nights with more sleep during weekends sounds like a tempting idea to maintain good cumulative sleep hours, but is a lost cause. Regular nightly sleep of good quality is what will most benefit your teenager in the long term.

Our teenagers’ future is the most important priority for us. That is why we warn them against developing bad habits and the risks of substances such as tobacco, drugs, and alcohol. This is precisely why we need to talk to them and help them understand the importance of sleep as well. Good sleep is necessary for your child’s development and good health and insomnia poses a serious threat to these. To learn more about how insomnia can affect your teen’s health or cardiovascular health, reach out to the best cardiologists in Bangalore at the Sagar Heart and Vascular Institute.

All you need to know about Delta Plus Variant

Since last 2 years, global healthcare is going through a challenging phase. What continues to keep the whole world on their toes is how to jointly deal with two situations; Pandemic and Panic. The Covid-19 virus continues to keep everyone guessing, but what still lingers in the mind of millions across the globe is, continued panic.

Just as all of us in India and overseas begin to heave a sigh of relief that the second wave is slowly coming to control, experts have found out another variant of the virus, this time, even more deadly and dangerous than the earlier ones – The Delta Plus.

Here, we talk about the Delta Plus Variant, the symptoms, risk factors and how to manage the situation.

What is the Delta Plus Variant?

Ever since it came into limelight for the first time in 2019, Coronavirus has been constantly changing forms and turning out into something more fearsome than its previous version. Labelled as, ‘a variant of concern’, this new mutant version of the Delta strain of Covid is known as Delta Plus.

The Delta Plus (B.1.617.2.1/ (AY.1) is seen as the next generation of SARS-COV-2. Research continues across the world to understand its severity and implications in greater depth. Studies conducted so far suggest that the Delta Plus variant is the result of the mutation in the spike protein of SARS-COV-2, which helps the virus enter the body and infect the human cells.

What are the symptoms of the Delta Plus Variant?

Top Virologists from across India and overseas have said that the symptoms of the Delta Plus variant are a combination of the Delta variant as well as its partner, Beta. They include, cough, diarrhoea, fever, headache, skin rash, discolouration of fingers and toes, chest pain, and shortness of breath.

Patients may present some other symptoms too like Stomach ache, nausea, vomiting and sudden loss of appetite.

Why is the Delta Variant a cause of concern?

Delta Plus has shown an increased ability to spread almost 60-70 times faster than its predecessor, the Delta variant. According to experts and studies conducted, this variant can easily attack the lungs and cause immense damage, leading to serious complications. According to one of the former senior most scientists associated with the Indian Council of Medical Research, two graded mutations which have occurred within the Delta variant have contributed to higher and faster transmission efficiency. This makes the Delta variant even more threatening than its predecessors.

Treatment and Support to manage the Delta Variant

Although medical experts are of the opinion that it is a bit early to predict the effectiveness of the existing vaccines on the new variant, they are of the firm opinion that Vaccination and safety measures such as wearing of face masks and maintaining physical distance are extremely critical to fighting the Delta Plus coronavirus variant, Detailed research continues on a war footing to find out more on how to arrest this rapidly surging variant.

The Bottom Line

At Sagar Hospitals, our interdisciplinary team of experts handle Delta plus variant infections in our patients, with utmost care and efficacy. In light of the continued variations observed in the behaviour of the Corona virus, it becomes increasingly difficult to predict when and how the virus will lose its stranglehold on human life. Till a concrete solution is arrived at, it becomes our independent responsibility to take care of ourselves and not ignore the slightest of the symptoms.

To know how you can be safe from the dangerous consequences of the Delta variant, meet our expert doctors at Sagar Hospitals for complete guidance and steps to be taken to stay safe and healthy.

Steps to Covid Recovery Plan

Covid-19 has been a pandaemic with a difference. Different in many ways as it continues to change faces. While to begin with, the symptoms of Covid-19 were similar to those of a patient with a common flu, with passage of time, patients started presenting with newer type of complaints which ultimately resulted in testing positive for the virus.

A unique point about this particular virus is that even if a person considers himself to have completely recovered, there is still every possibility that he may catch the infection again. This makes it extremely important for not only the recovered patient but those around him, to continue to strictly follow Covid-19 safety protocols as laid down by the health department and government.

In addition to Basic Protocols like wearing of mask, washing hands at regular intervals and maintaining a physical distance, there are certain important steps to be followed, to ensure a steady recovery from the dreaded virus.

Steps towards recovery from Covid-19

As it would happen with many patients, who would recover from various types of serious diseases, the fear of contacting the illness once again, can continue to haunt even Covid patients. Hence, it is required to formulate a methodical recovery program to ensure that start feeling confident all over again.

Taking care of emotional well-being

The very fear of having contacted Covid-19 can cause lot of anxiety to patients and their families. Hence it is extremely important for the families to ensure that the patient stays positive. It is necessary not to dwell on tough days passed by and prepare mentally towards recovery to begin with. Getting back to routine activities slowly will help in creating a fresh feeling of confidence.

Maintain a healthy diet routine

It is very important not to miss your daily meals. Include energy rich cereals in your diet like cereals, pulses, milk and milk products. Consume more of seasonal fruits and vegetables and leafy vegetables. These help in strengthening the immune system. Stay hydrated as much as possible and drink lots of water.

Regain Your Strength

Covid-19 can cause extensive damage to the lungs and respiratory system. Hence recovery would take some time. It is not a bad idea to reach out to an occupational therapist. He can help you on your road to recovery, by helping in adjusting to new energy levels. To support your recovery program, cut down on excess and strenuous activities.

Practice Breathing Exercises

Breathing Exercises can be extremely useful in helping giving momentum to the lungs. Regular sessions of Pranayama and Chest exercises can help reduce breathlessness.

Get yourself tested for Covid-19

Recovery symptoms can vary from person to person. Hence, it is advisable to have a Covid test is any symptoms persist for a long time. For those who recover, chances of getting re-infected are low for the first three months.

The Bottom Line

Covid-19 has shown itself to be a very tricky virus to deal with. The need of the hour is to continue to stay safe even after full recovery. It is extremely important to follow all safety protocols as chances of getting re-infected due to ignorance can be very high. Today, we have vaccines at our disposal which can make a huge difference. Getting vaccinated should be top priority after the scheduled period of recovery is over. How long Covid-19 will continue to keep us humans on our toes is unknown but following safety protocols should never be compromises.

Mental Preparedness before getting vaccinated

The Covid-19 virus came with no prior warning. Not only did it rattle the global healthcare sector, but also threw the global economy, completely out of gear. Exactly a year ago, researches and studies began to find out an answer to the dreaded virus. It was not impossible but a dream for sure, then. Today, thanks to the stupendous and tireless efforts of our distinguished scientists, the dream has transformed into reality, in the form of indigenously developed Covid-19 vaccinations, much to the delight of everyone.

While vaccinations have been administered in the past to prevent diseases like Cholera and Polio, the Covid-19 vaccine had to be a new discovery and tested not once but multiple times, to prove that it is completely safe and effective. Over and above this, convincing the consumer about its safety with bare minimal side effects too was a challenge for doctors. All this required getting people mentally prepared to take the vaccine.

Here, we talk about how to get mentally prepared to take the vaccine.

Vaccines and Covid-19

A cocktail of emotions, while dealing with the Covid-19 pandemic, including extreme fear, anxiety, panic, grief, guilt, loss of loved ones and uncertainty about livelihood, have all led to countless health issues. Today, with two of the most effective vaccines developed by our own country and successfully in use, citizens can breathe a bit easy with hope of surviving the effects of the deadly virus. Being the first of its kind to be developed within India, there surely will be certain doubts among citizens on its effectiveness and after effects. However, the point to be remembered here is that no vaccine is released for public use unless it is certified to be completely safe and adequate alternative medication is made available to cope up with any possible after effect. It is more to be prepared mentally and feel completely confident.

How do we prepare mentally to get vaccinated?

With different types of vaccines available now to choose from, the doubts in the minds of citizens about which one is most effective, is quite understandable. In many ways, Covid-19 vaccines are just like the other vaccines, you would have seen before. It is therefore necessary to plan your vaccination schedule in such a way that you give yourself sufficient time to recover from possible after effects of the vaccine, which in most of the cases, are very mild.

Here are a few suggestions.

1. Plan your appointment

It is wise to plan your appointment before any significant commitment to help you overcome any mild side effect. Choose a vaccination centre close by to your residence.

2. Maintain the same vaccine across both the dozes

It is very important to the same vaccine type till you finish both the schedules dozes. Any change of vaccine type in the intermediate period can lead to certain side effects.

3. Have pain relievers on hand

Side effects are normal after vaccination. Most people experience mild side effects like fever, pain at the vaccination site or headache. It is good to keep some pain relievers like paracetamol tablets in stock.

4. Stay hydrated

Have your routine breakfast or lunch depending upon your scheduled appointment for vaccination and stay hydrated. Some people may get nervous when they get any kid of shot. This can make them feel dizzy. Proper nutrition and hydration can combat that.

5. Avoid Alcohol and Smoking

Stay away from Alcohol and Smoking before and a couple of days after vaccination. This will help in managing after effects of the vaccine in a better way.

The Bottom Line

Intense efforts have gone into the development of vaccines for Covid-19. While vaccination is extremely important, it is also necessary to adhere to Covid-19 protocols strictly, to stay protected. The best solution to reduce anxiety is to go the nearest designated vaccination centre and get vaccinated.

For more information on Covid-19 vaccinations please get in touch with our medical experts at Sagar Hospitals in Bangalore. Stay Safe Stay Healthy.

Long COVID explained. Are you at risk?

Covid-19 has taken its toll on the healthcare infrastructure globally and nowhere is it more apparent in India. The struggles of finding oxygen cylinders, concentrators, hospital beds, and ICU beds with ventilators have made the health crisis impossible to ignore and the focus of the nation’s attention.

Accounts of recovered Covid-19 patients and various studies around the world, however, seem to signal a more drawn-out, lingering struggle. Though there isn’t an exact definition for “Long COVID,” it is synonymous with the long-term impact of Covid-19 even after a patient tests negative for it. While Covid-19 symptoms seem to pass for most people after recovery, some seem to suffer the effects of the illness weeks and even months after the initial infection. New studies show that both the elderly and the young are susceptible to Long COVID.

Here, we discuss Long COVID in detail, the risks, its symptoms, and how to manage the condition.

What is Long COVID?

Long COVID is a term that describes the post-Covid-19 symptoms experienced by patients much after they have recovered from the initial infection. While most people with mild to moderate infections recover within 2 weeks, Long COVID patients experience post-Covid-19 complications that persist for months. Though there isn’t a precise duration that is used to define Long COVID, symptoms that persist for 8-12 weeks and beyond are generally considered to qualify for Long COVID. People suffering from these symptoms are known as long-haulers.

Research from multiple studies and on-ground emerging testimony from medical professionals identify two main groups of long-term symptoms: respiratory and multi-organ. Respiratory symptoms such as breathlessness and cough are most common and also include lung fibrosis, headaches, and fatigue. The second group of symptoms affects many organ systems of the body, including the heart, the nervous system, kidneys, and more. In the study from COVID Symptom Study app (UK), 4182 people reported long-term symptoms such as cognitive impairment (or “brain fog”), anxiety, heart palpitations, numbness, and “pin and needles.”

How many people get Long COVID? Who is at most risk?

Details regarding the number or proportion of people that suffer from Long COVID are still emerging. People with comorbidities, however, are a group at risk in particular.

A study by the Stanford School of Medicine found that more than 70% of patients hospitalised for Covid-19 suffered various symptoms months after recovering from the initial infection.

In a study led by the University of Leicester of over 1000 participants who had required Covid-related hospitalisations reported that 70% patients did not make a full recovery 5 months after being discharged. Nearly 18% of those who were working before contracting Covid-19 could no longer continue working afterward. A further 19% reported having undergone a health-related change at their workplace.

According to the estimates provided by the Office for National Statistics, 20% of long-haulers in the UK found their daily activities and quality of life severely impacted by Long COVID symptoms.

Studies are showing that it is not only the hospitalised patients with moderate to severe COVID that are susceptible to Long COVID, but non-hospitalised patients with milder cases as well. As per a survey conducted by the US CDC (Centers for Disease Control and Prevention), 35% of non-hospitalised patients with mild Covid-19 suffered various symptoms well after 21 days. This includes patients in the 18-34 age group where 20% reported ongoing symptoms.

Overall, research shows that nearly 33% of non-hospitalised Covid-19 patients will be experiencing Long COVID symptoms up to 3 months later, and some for even 6 months or longer. In comparison, only 10% of flu patients are still sick after 14 days.

What are the symptoms of Long COVID?

Many Long COVID patients experience the same Covid-19 symptoms from their initial infection, albeit for months. Post-Covid-19 symptoms can range from 4-12 weeks for most long-haulers and longer (up to 6 months or more) in rarer cases. Some people can develop new symptoms also, such as hair loss, and undergo cycles of improving and then getting worse.

Symptoms of Long COVID include:

● Fatigue: Severe fatigue and tiredness is a common Covid-19 symptom that, according to researchers, is prevalent in recovered patients weeks after testing negative for the initial illness. Covid-19 severely affects the immune system and the body as a whole, and it is apparent from patient testimonies. Long-haulers complain of long-term fatigue and an inability to resume physical/ daily activities at pre-illness levels for months.

● Anxiety and depression: Covid-19 can put an immense mental strain on patients with the possibility of health levels plummeting in a short span of time. This is worsened in the backdrop of health services under duress with necessary medical resources in short supply—all while isolating or quarantining. This toll on mental health can continue much after the initial recovery (as PTSD in extreme cases) and be exacerbated by other physical post-Covid-19 symptoms.

● Brain fog/ cognitive impairment: Brain fog is a common post-COVID symptom that can severely disrupt the functioning of the central nervous system. Covid-19 can have a direct impact on the brain and when it affects other organ systems as well, this effect is compounded.

Brain fog can interrupt cognitive abilities, resulting in confusion and mental fatigue. It can make it very hard for people to concentrate effectively and focus on tasks.

● Shortness of breath/ dyspnea: Patients can still suffer from an inability to breathe smoothly weeks after recovering from their initial Covid-19 infection. This can indicate fatigue and low oxygen levels in the body and can lead to chest pain if not managed in time.

● Heart palpitations: The immune response to fight the coronavirus infection can cause high inflammation in the body that can damage healthy tissue, including the heart and lungs. Post-Covid-19, this can manifest as rapid or irregular heart rates or palpitations.

● Chest pain: Chest pain post-Covid-19 can happen due to myalgia (muscle pain or soreness) from a severe bout of COVID. This can make the area sore to the touch and movements such as turning or twisting the chest can be painful. Long-haulers can also suffer from non-cardiac or non-specific chest pain that can be sharp or dull. These symptoms can ail recovered patients for weeks.

● Joint or muscle pain

Treatment and support to manage Long COVID

Considering that Long COVID can impact many organ systems, health experts from across the globe and at Sagar Hospitals suggest a multi-disciplinary approach for dealing with Long COVID. Doctors from various disciplines such as infectious diseases, cardiology, pulmonology, and others must work together to focus on increasing the lung capacity and physical strength of Long COVID patients.

Our doctors at Sagar Hospitals suggest pacing yourself, taking adequate breaks, and gradually increasing the amount of exercise to manage breathlessness and fatigue. Flexibility exercises and controlled strength training can help relieve joint and muscular pain. Finally, our experts advise you to not ignore your mental health and to be kind to yourself during recovery.

In light of recent research and numerous testimonies from recovering Covid-19 patients, post-Covid-19 symptoms that stay with people for months after the initial infection may be the next global healthcare challenge. Long COVID has proven to affect not just hospitalised patients but patients suffering mild COVID as well. These lingering post-Covid-19 symptoms can severely impact the daily lives of patients and even affect employment. As more studies are conducted on Long COVID, more information on its impact on recovering patients will come to light.

To find out about multi-specialty and multi-expertise medical teams that focus on providing holistic care to rehabilitate recovering Covid-19 patients, reach out to our experts at Sagar Hospitals.

Mucormycosis: what is the “black fungus?”

As the second wave of the Covid-19 pandemic rages across India, a fungal infection known as mucormycosis (or commonly as the "black fungus") is being reported in increasingly high numbers amongst recovering and recently recovered Covid-19 patients. The country now faces the prospect of multiple health crises with the "black fungus" being declared a pandemic by many states. The rampant mucormycosis infections have added yet another dangerous complexity to the recovery of Covid-19 patients and created more panic amongst the citizenry.

What is the "black fungus?"

Mucormycosis is a rare but serious fungal infection caused by a group of moulds known as mucormycetes. These moulds are prevalent in our natural environment as spores in the air and in places such as the soil, plants, manure, and decaying vegetables and fruits. It is so ubiquitous that it can be found even in the nose and mucus of a healthy person.

Mucormycosis generally affects immunocompromised individuals (people with a compromised ability to fight viruses, germs, and other environmental pathogens). Patients recovering or recently recovered from Covid-19 typically suffer from a weakened immune system, and are being found to be susceptible to mucormycosis infection. The infection affects the sinuses, the lungs, and the brain.

With an overall mortality rate of 50%, it can easily be life-threatening in immunocompromised people.

What are the risk factors for contracting this infection?

In spite of the seemingly close association with Covid-19 recently, "black fungus" does not spread by direct contact - neither by person-to-person contact nor by droplet spread. This fungal infection also does not spread through oxygenation, humidifiers, or water. The fungal spores are found indoors as well as outdoors and enter the respiratory tract via inhalation.

Though there are some linkages cited by doctors with overuse of zinc and iron supplements, the main risk factors for contracting mucormycosis infections are believed to be the following:

● Drug-related compromised immunity from steroid overuse, immunosuppressant drugs, or chemotherapy.

● Diabetes or hyperglycemia (high blood sugar levels).

● Immunocompromised patients suffering from conditions such as cancers and HIV/AIDS.

What is the link between Mucormycosis and Covid-19?

In spite of the seemingly close association with Covid-19 recently, there is no direct link or causation between Covid-19 and mucormycosis.

There are, however, many factors that are closely connected to Covid-19 cases that increase a patient's susceptibility to contract the infection:

● Diabetes: Uncontrolled diabetes contributes to weakening the immune system. With an already compromised immune system, a Covid-19 patient has an additional complication with diabetes. A history of uncontrolled blood sugar levels not only exposes these patients to the risk of contracting more severe illnesses but also encourages the "black fungus" infection to thrive in the body.

● Steroids: Steroids are used to reduce inflammation in the lungs of Covid-19 patients and help control lung damage when there is an overly strong reaction from the immune system to fight the coronavirus. These drugs, however, can in addition to controlling the immune response also weaken it severely. They also push up blood sugar levels in diabetic as well as non-diabetic patients.

This sets upon a cycle of conditions that can leave a Covid-19 patient severely immunocompromised. First, diabetes (or poor sugar control) reduces the body's immune defences, then Covid-19 worsens it, and finally, non-judicious use of steroids cripples the immune system. This plummet in the immune response of Covid-19 patients leaves them vulnerable to a mucormycosis infection.

● Comorbidities, immunodeficiencies, and immunosuppressants: Patients suffering from comorbidities (such as diabetes) or immunodeficient conditions (such as HIV/AIDs) already have a weak immune system to protect them. Patients taking immunosuppressive medications (such as chemotherapy, corticosteroids) to fight severe diseases and environmental pathogens are in a similarly vulnerable situation. Such patients are at a high risk of contracting fungal infections. Ailing Covid-19 patients, whether diabetic or surviving with immunosuppressant drugs have low defenses against fungal infections such as mucormycosis.

What are the early symptoms to watch out for?

Mucormycosis, with a mortality rate of 50%, can be life-threatening. Though controlled mainly with antifungal medication, it is not uncommon for patients to require surgery and lose an eye or the upper jaw.

It is important that you pay attention to early signs of a possible mucormycosis infection to prevent severe complications:

● Pain and redness around the eyes and nose, accompanied by fever.

● Swelling of the forehead and headaches.

● Local pain and swelling in the one side of the face or cheekbone.

● Loosening of teeth and reduced jaw involvement.

● Blackish discolouration or crusts around the bridge of the nose or palate.

● Blurred or double vision, accompanied by pain.

● Pulmonary symptoms such as nasal blockage/ discharge (bloody or black in colour), nosebleeds, reduction in facial sensations.

● Respiratory symptoms such as trouble with breathing, chest pain, and coughing.

How do you prevent or minimise "black fungus" infection?

Mucormycosis remains a rare infection amongst non-immunocompromised people.

Experts at the Sagar Hospital advise the following to prevent a black fungus infection in immunocompromised patients:

● The fungi spores thrive in damp, high moisture environments. Unsanitary environments where patients are being treated or oxygenated can become a source of infection in the absence of proper ventilation and cleanliness. All environments of recovering patients, whether medical or home, must be kept as sanitary as possible.

● Unsystematic and overuse of steroids can push down immunity and raise blood sugar levels. The prevalence of both these conditions increases the chances of contracting a mucormycosis infection. One way to stall the possibility of the fungal infection is ensuring that Covid-19 patients, in treatment as well as after recovery, are administered the right dose of steroids at the right time and for the right duration. Patients should avoid self-medication and treatment should be strictly under a doctor's guidance.

● It is strongly recommended that hyperglycemia be monitored and controlled. Blood sugar levels of diabetic as well as non-diabetic patients being treated for Covid-19 must be kept in check. Doctors should also monitor patients discharged from Covid-19 treatment for blood glucose levels, especially in diabetics.

Treatment

Management of Covid-19 patients is an interdepartmental effort of internal medicine specialists, ENT specialists, microbiologists, ophthalmologists, dentists, and maxillofacial surgeons. At Sagar Hospitals, our interdisciplinary team of experts handles mucor infections in our patients with utmost care and efficacy.

For Covid-19 patients being treated for mucormycosis, our experts strongly recommend controlling diabetes and hyperglycemia, reducing steroid use, and discontinuing the use of immunosuppressant drugs. Following medication and procedures, intravenous antifungal treatment may be required.

While primarily treated with antifungal medication, a mucormycosis infection may eventually necessitate surgery.

The "black fungus" has become a pandemic in India in its own right and naturally created worry in a population already reeling from the pandemic. While not a common infection at all, mucormycosis is a high risk for the immunocompromised such as Covid-19 patients. Overuse of steroids and uncontrolled blood sugar levels further makes patients even more vulnerable to this fungal infection. However, infection can be prevented and treated with monitoring of hyperglycemia, strict control of steroid use, and control of immunosuppressant conditions. For more information on mucormycosis and its control reach out to our experts at Sagar Hospital.

Covid-19 is confirmed airborne. Now what?

With the clamour of scientists growing louder and evidence piling every day, the discussion of airborne transmission of Covid-19 has finally come to a consensus with the CDC and WHO both making the announcement official. The medical bodies have updated their guidelines nearly a month after a report in the medical journal Lancet backed by many scientists claimed that there is strong and consistent proof that the SARS-CoV-2 virus is transmitted predominantly through the air.

What does “airborne” mean, exactly?

Clarifying the meaning of the word “airborne” is a great place to begin considering the amount of panic and misconception this single word has created in the general public—especially in India. The scientific meaning of the word isn’t the same as its commonly used or understood meaning.

“Airborne” does not mean that the SARS-CoV-2 virus spreads in the open air, that outdoor air is dangerous, and that the virus is potentially everywhere around us. No, you also do not need to wear N-95 masks at all times to protect yourself. What it does mean is that the previously accepted theory that the SARS-CoV-2 virus spreads primarily through large droplets that travel only short distances (less than 2m) has been discarded. It is now believed that the virus can travel much farther (close to 10m) and can collect in the air of a closed space in the form of aerosols.

As panic-inducing as it can be to read a news headline that the coronavirus is airborne with the implication that there is seemingly no safe distance between the virus and you, and that risk is nearly unavoidable, it is actually a call-to-action to open your windows instead of closing them.

Droplets or aerosols?

Since the pandemic began, the question of how the coronavirus transmits has been the subject of greatest importance in the effort to curb the virus. It was earlier suggested that the SARS-Cov-2 virus spreads mainly through large droplets that are produced when a person sneezes, coughs, or talks loudly. It was believed that these droplets, since they were of large size, could only travel short distances and fell to the ground. With this understanding, a person standing 2m (6 feet) away was considered safe from viral transmission.

However, by studying contact tracing data over the world, researchers found that the “super-spreader” events tended to occur in venues and events where people tended to linger longer: in offices, conferences, retail stores, indoor restaurants, and most importantly, homes. Transmission was found to be more likely when people spent more time together in a closed environment. Over time, the evidence for aerosol-based airborne transmission became overwhelming, and that for droplet transmission hard to find.

Experts over the world are now of a collective opinion that public health measures that fail to treat the virus propagation predominantly through airborne transmission leave the public unsafe and allow the virus to spread.

What is the new advisory?

The US Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and Union Health Ministry (India) have recognised that SARS-Cov-2 is airborne and can be transmitted through respiratory fluids, which are fine droplets or aerosols that are released during respiration. This means that the SARS-CoV-2 virus can be transmitted when an individual inhales respiratory aerosols produced when a COVID-infected person exhales (including quiet breathing), talks, sneezes, coughs, sings, or shouts. Public guidelines now include “airborne transmission” as a possible mode of coronavirus transmission.

These aerosols or respiratory droplets that carry the SARS-CoV-2 virus and transmit infect exist across a spectrum of sizes. The virus can travel on very small particles that can build up indoors but disperse quickly and easily outdoors. Indoors, these particles can travel much farther than the stipulated social distance of 2m (6 feet). These exhaled respiratory fluids can settle on surfaces or remain suspended in the air, building up. Although large droplets settle down to the ground within seconds to minutes, the very small droplets and aerosols can remain suspended for minutes to hours in a poorly ventilated space.

This is why the straightforward public health messaging in Japan is to avoid the 3 Cs—closed spaces, close contact, and crowds.

What should you do, especially regarding indoor ventilation?

The risk of transmission increases greatly in closed, poorly/ unventilated spaces because respiratory fluids and aerosols can quickly spread and concentrate in such areas. You should keep your indoors well-ventilated by keeping windows and doors open to ensure good air circulation and by using exhaust systems.

It is repeatedly stressed that the risk of coronavirus transmission is markedly lower outdoors because virus-carrying aerosols dissipate quickly in the open air. It is advised that you take measures to improve ventilation in homes, offices, and public spaces. Simple and strategic placement of fans, open windows and doors, and exhaust systems introduce outdoor air and improve the quality of air inside. Creating cross-ventilation goes a long way in curbing the transmission of Covid-19.

Therefore, indoor spaces such as indoor restaurants where mask protection is compromised while eating and have plexiglass separators to create a physical barrier between diners don’t actually provide much protection against viral transmission. We have also enjoyed a false sense of security with a social distance of 6 feet and the “sanitisation theatre” in airports, public offices, and other public spaces. A focus on ensuring good ventilation and should be a much bigger priority than the manic disinfection of all surfaces and store-bought items.

These precautions are underpinned, of course, by continued use of face masks and hand washing/ sanitisation.

In the face of it, the new advisory may seem contradictory to earlier precautions. But digging deeper into the CDC and the Indian government advisory, we see that the breadth of precautions has only been expanded, and they do not contradict earlier guidelines. Transmission of Covid-19 being considered airborne does not indicate in any way that outside/ open air and ventilation are the new public enemy. In fact, it only reiterates the knowledge that closed spaces and close contact are where the SARS-Cov-2 virus is transmitted most easily, and that good ventilation and open spaces combined with mask wearing and vaccination are the most potent weapons against Covid-19.

5 Benefits of preventive healthcare that could save your life

The age-old proverb “prevention is better than cure” though overused, holds true. The proverbial cure is usually expensive, painful, and not convenient in the least. To put things in perspective, consider the use of seatbelts—they are affordable, easy to use, and provide a robust prevention capability against injury. The consequence or price of not using seatbelts can be quite serious and regrettably dire. The same principle of prevention works with our personal health as well.

Preventive healthcare mostly revolves around 3 things:

• Maintaining a balanced and healthy diet.

• Keeping physically and mentally fit.

• Regular health checks for early detection of diseases.

Your chances of getting cured or being able to successfully manage a non-communicable disease (NCD) are much slimmer after being diagnosed with it. In fact, as reported by WHO in 2018, non-communicable diseases are responsible for 70% of global mortality. Regular health checks are the kind of preventive measures that can help you stay a step ahead of diseases.

The following are the 5 benefits of preventive healthcare:

1. Detecting diseases early can be life-saving

The top four global causes of death are chronic diseases that are preventable and manageable with regular access to basic healthcare.

They are:

• Heart disease: Heart conditions are usually caused by obesity, bad diet, and a lack of cardiovascular exercise.

• Cancer: The most common kind of cancer, lung cancer, is caused by smoking and genetic factors.

• Stroke: Like heart disease, stroke is mostly caused by obesity and poor nutrition.

• Chronic lower respiratory disease: Smoking is by far the greatest risk factor, causing 80% of the cases.

In India alone, NCDs are responsible for 61% of all deaths. Preventable diseases caught early increases the chances of surviving them. Breast cancer and prostate cancer can be detected in women and men in early stages with regular health screens such as mammograms and prostate cancer screening (check-ups are advised starting at the ages of 40). The chances of early detection, in turn, are much higher if you have a preventive mindset with a willingness to get regular health check-ups done.

2. Timely prevention can save you from crippling medical bills in the future

As per the National Health Accounts, 2013-14, only 9.6% of the overall medical expenditure in India is on preventive healthcare. Simply put, over 90% of overall healthcare expenses are towards treating diseases and their various complications. This translates to a staggering national bill of Rs. 3.6 lakh crore per year. With skyrocketing costs of medical care, most people from the poorer sections of society end up selling property and personal possessions to keep up with the burgeoning medical expenses.

The management and treatment of chronic diseases such as heart disease and cancer is exorbitant and can easily run into lakhs. Being covered under health insurance (according to reports by RedSeer, only 25% of the Indian population has health insurance) in the present can prevent hefty out-of-pocket (OOP) payments in the future. Investing in preventive healthcare allows chronic diseases to be discovered early and for you to avoid expensive medical treatment for conditions that have progressed past regular management.

3. Early diagnosis = early treatment

Knowledge is power—and regularly checking for high cholesterol levels, blood sugar, and blood pressure helps you catch chronic diseases early even if you don’t have symptoms. Preventive health checks let you know what’s going on in your body and what needs to be addressed immediately. This information that can be gleaned from simple and inexpensive blood tests can provide you the necessary insight to make adequate changes in your lifestyle and diet for early treatment of the condition. In many cases, it can minimise the necessity of seeking specialist care from specialist doctors such as cardiologists, endocrinologists, and neurologists.

4. Avoid or reduce symptoms of illness

Sometimes, avoiding a non-communicable disease altogether is not an option due to genetic factors and constraints related to ability. In such cases, the easy management of symptoms becomes important for reduced risk and better quality of everyday life. One of the biggest advantages of working with a proactive and preventive mindset is that NCDs such as cardiac disease, type 2 diabetes, hypertension, and conditions caused by smoking or alcohol consumption are targeted first. The management of these diseases beyond regular stages can be lengthy and difficult. Their early detection plays an important role in effectively managing or avoiding their symptoms.

5. Improved quality of life

Timely preventive screenings such as mammograms can lower health costs, introduce an early intervention, and invariably improve the quality of life. NCDs can have debilitating effects on your ability to be productive and your career. Dealing with advanced stages of NCDs impacts your everyday activities and mental health. Detection of serious illnesses in the early stages can help you prevent not just symptoms but chronic inconvenience as well.

Much like the seatbelt, the cost of which is only a fraction of the overall cost of accident care, preventive healthcare is one of the most efficient methods of maintaining long-term good health. Regular check-ups provide you early markers of worsening conditions for you to make timely and inexpensive lifestyle changes to not just mitigate an illness but improve your overall health and longevity as well. Detecting illnesses and non-communicable diseases in the early stages allows you to seek treatment when it is most likely to work best. With the life-changing and life-saving potential of preventive healthcare, it should be seen as a compulsory part of your overall health. For more information on preventive measures against chronic and life-threatening diseases, book an appointment with our experts at the Department of Preventive Healthcare at Sagar Hospitals.